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Posts from the ‘Joy Jacobson’ Category

Medicine IS Humanism

Diane Kaufman

Diane Kaufman, MD; photo by Scott Friedman

This guest post is by Dr. Diane Kaufman, a child psychiatrist, poet, and passionate advocate for arts in healing. Her poem “In Memory of the Future,” in honor of the Newtown, Connecticut, shooting victims, is powerfully performed by Newark Arts High School students. Click here to watch the video of their performance.

The practice of medicine revolves around people. A person in need is at the center of the health-caring circle, and all around are other people who are trying to be of help. Blood tests, respiratory devices, infusions, MRIs, and other forms of advanced technology at their very best diagnose and treat, and that is so very important and essential, but they alone can not care. They are not alive, and they know nothing about love, joy, kindness, sorrow, loss, dying, death, and the cry of a newborn child. Only human beings can care—that is, if they choose to do so. If they are encouraged to do so. If they have experienced other human beings caring for them and about them.

And it all starts with each of us. Do we have the courage to express the humanity of our own beating and sometimes breaking heart? Do we have the passion and determination to change a culture of business as usual? To acknowledge that the “hidden curriculum,” can become more powerful than all the humane lessons we are taught in lecture halls? That hidden curriculum, the one not spoken of aloud but acted upon, is rather the anti-practice of medicine, the health-uncaring institution.

The cure, I believe, is not “humanism in medicine.” Because to me, the phrasing and the timing are all wrong. Let us pause, take a deep breath, remember deeply, and bring to mind what we seem to have forgotten. Medicine IS humanism. As Hippocrates said, “Wherever the art of medicine is loved, there also is a love of humanity.” And from that foundation, life-affirming questions can be asked:Who are these unique people who have come to me for help? 

  • What is their story?
  • How can I respond to their needs?
  • What kind of doctor am I?
  • What are the qualities of my medical practicing?
  • What does my health care institution reveal about how it cares for human beings who are sick?
  • How does this institution care for those who are trying to be of help?
  • And what intentional actions can I bring to my encounters with these center-of-the-circle people that show I care and that because I care, I am a more competent, effective, and professional physician?

This is not a quiz, but it is a test of how we will respond each day to the call of being a physician. One day we will all be at the center of that circle. When “connectivity units” are equal to “productivity units,” or better yet, when it is comprehended that there is no lasting productivity without caring and connection, the art of medicine will be practiced.

What We Talk About When We Talk About “Diversity”: An Interview with Kenya Beard

Kenya Beard

Kenya Beard

On June 18 nurse practitioner and nursing educator Kenya Beard and CHMP senior fellow Jim Stubenrauch and I will be leading Narratives of Diversity: Encouraging Cultural Responsiveness, a daylong event in which we’ll use exercises in reflective narrative to explore issues of diversity and marginalization in health care and health professions education. Our goal will be to foster awareness and generate ideas for making academic and clinical settings more inclusive (the event will be held at the CUNY Graduate Center in New York).

Kenya and I talked earlier this week about her work in promoting multicultural education as a way of increasing diversity in the health professions. Kenya has been a nurse for 28 years, in the emergency room, in a medical-surgical unit, and in home care. She got her doctorate in 2009 and for several years has been on the faculty at the Hunter–Bellevue School of Nursing, where she’s also the founding director of the Center for Multicultural Education & Health Disparities, which “seeks to promote educational reform and restructure institutions in an attempt to strengthen multicultural awareness and workforce diversity.” She is a faculty scholar at the Josiah Macy Foundation, and in 2013 the National Black Nurses Association named her nurse educator of the year. She recently received the Witten Award for Educational Excellence at Hunter College. The following is a lightly edited transcript of our conversation.—Joy Jacobson, CHMP senior fellow, @joyjaco

You’ve worked as a nurse practitioner in home care for a long time. How does your work with patients open your eyes to health care disparities?
When I became a home care nurse I had some patients who were African American grandmothers. I would say, “Miss T, you want your blood pressure under control!” I wanted them to live; I didn’t want them to be a statistic. I would go to the cabinet and say, “This soup is very high in sodium. The sodium is killing you. You have to get rid of this soup.” The next week I’d go back and see the same soup. I never said, “Tell me what’s important to you.” I had to realize I lost some of my identity. It was more like, “Now I have the credential, and let me tell you what you need to do to get better. Let me help you.” We tend to do that.

Isn’t that how a nurse helps a patient?
When I went to school the focus was on educating your patients to help them make autonomous decisions. But when you dissect it—how are we helping them make those decisions? Were we taught from an ethnocentric lens? Joseph Betancourt is a physician at the Disparities Solutions Center at Massachusetts General Hospital, and he says the first thing we need to ask patients is what the disease means to them and what they call it in their culture. We need to take the time. And we don’t have enough time. We have to take the time to listen to patients. If we don’t take the time, the outcomes are going to be what we have had for the last 60 or 70 years, which is health care disparities. A report came out a few years ago that said we spent over a trillion dollars in three years related to health care disparities.

It’s about the nurse being comfortable supporting the patient’s cultural beliefs and decisions even when they conflict with ours.  That can be a hard pill to swallow. We’re in it to save lives. We’re not taught to say, “If the person is okay with this we should support that.” Instead we sometimes imply, “Your cultural beliefs are wrong. You need to listen to me!”

You talk about multicultural education. How is that different from the traditional health professions education?
Everyone comes in for an in-service on cultural competence and they check it off like fire safety. But multicultural education is a reform model that looks at the whole institution. James Banks says it has five dimensions, the first of which is content integration. Where are we getting this content from? For example, many curriculums add on separate books for LGBT concerns and the elderly. But it can’t just be an add-on. We have to see how different populations view illness and disease.

I have classrooms that are so diverse. One student of mine who was Hispanic explained to the class that there was no way in the world her grandmother would change her diet. There was a certain staple in the grandmother’s diet that was contributing to her high blood sugar. She was okay dying at 70 because her quality of life was so great. We did a role-play where an NP said, “We’ve got to get the hemoglobin A1c below 7; she has a 7.6.” The institution isn’t getting full reimbursement unless they have those kinds of outcomes. You can’t operate unless you have full reimbursement. So the philosophy is “Treat to target! Get her under 7!” They began the role-play and my students reminded me that we have no idea what to do when a patient doesn’t listen to us. But by listening to the patient they realized—oh, she does care! It blows their mind. They come away saying, “How do I help get her blood sugar under control without disrespecting her beliefs and values?” It has to start with a healthy relationship.

Many people might assume that health care providers know how to have relationships with patients.
We have a lot of assumptions that are contributing to health care disparities. The system is set up so that nurses assume that when patients are discharged with prescriptions that they will get them filled. If someone doesn’t take his prescription and ends up coming back he’s what some ER nurses call a frequent flier. Sometimes nurses never ask patients. We’re trying to change the system because of health care disparities. Diversity, cultural competence, and health literacy—those three things are crucial to improving the health of the nation.

What about access? What’s happened as a result of improved access to health care for minorities?
Healthy People 2010 and Healthy People 2020 were all about access and quality care. And the ACA is broadening access for minorities. But if I have chest pain at the age of 48 and someone with blonde hair does too, she’s likely to have better outcomes. Why is that? We have to have conversations people aren’t prepared to have, about race, power, and privilege.

You can’t superimpose new initiatives onto old systems and just say “Do it.” Just like we couldn’t impose desegregation on educational systems without some negative ramifications. I am a product of that. They could bus you in but the teachers didn’t have to like you. I was told, “Just be glad you have an opportunity to have the books that the others have.” We had access but at what cost? I remember my first-grade teacher. One day she told us not to erase anything. I went to erase and she said, “Hey, I said no erasing!” And she bit my pencil eraser off with her teeth. My parents said she probably thought I was cheating. They always told me I had to look down at my paper: “Some teachers will think in order for you to get the A you must have cheated.”

I went to a public school where students were bussed in and where some teachers didn’t want to teach us. Are we doing the same thing with health care 50 years later? We talk about diversity, but if we impose it on a system that’s not ready for it, we’ll have tremendous chaos. A provider might get labeled for having bad outcomes from CMS [the Center for Medicare and Medicaid Services]. That person might look at the patient and think, “My outcomes are bad because of you.” I have seen it happen in education. I was at a meeting where someone said their nursing-exam pass rate was low because “we let them in.” My back got all sweaty. I wanted to say, “Hello, I’m in the room, I heard you!” I now welcome those moments. We can’t change anything unless we bring out what people really believe.

How can we encourage people to start examining their beliefs? I imagine not everyone welcomes that opportunity.
Banks talks about prejudice reduction. We all come with biases and we’ve got to expose them. If I’m raised in a household where my parents are saying, “Some of your teachers won’t want to teach you. They might think your scores will make them look bad,” now my lens is jaded. I think: were my parents right? Your beliefs and experiences are going to determine what you see as your reality.

We are all going to have different experiences. There’s no right or wrong; our differences shouldn’t tear us apart. Respect and empathy mean you don’t have to like it, just understand how a person could think that way. We need to build an environment to allow faculty to look in the mirror and ask: what’s working? What’s the hidden curriculum? You have your teaching philosophy. But are you asking your students what they need to succeed? If you do they might say, “I can never find him during office hours” or “When I asked her to explain she said I need to look it up, that I should know it.” What are your biases and assumptions?

Have you worked with doctors as well as nurses around these issues of diversity?
When I did a workshop on cultural competency recently none of the physicians came. When I asked one of my colleagues why, she said that physicians had to put cultural competency in the curriculum years ago. Some think it’s old hat, but health care disparities are still happening. We need to have a discourse on cultural competency in the clinical setting and we need to do it as educators.

People need to talk about diversity initiatives. I’m not there to be the citadel of knowledge. People need a platform to engage in a discourse that allows them to talk and vent. They are in institutions where they sometimes feel marginalized, and they want to be part of a movement that empowers everyone.

How do you help people handle the discomfort that can come up when we start to talk about diversity?
Bob Kegan has written about the orders of consciousness. As children it’s all me me me. But in the fifth order of consciousness it’s not all about you. You’ve shifted to asking what’s best for you and for other people. Most adults never reach the fifth order. But this order is along the lines of Gandhi and Martin Luther King, people who see beyond themselves and see their role in society as making a positive difference. That’s about 5% of the population. The first step is raising awareness.

Kegan plays this movie clip where one man kills another in a religious war and feels tremendous guilt that the son is now an orphan. Gandhi tells the man that he should raise this young boy. But he has to raise him in the religion of his father. That’s what being at that higher order of consciousness is about. Being able to see our interdependence on others and realizing that by helping others we help ourselves. But how do institutions foster patient-provider relationships that recognize our interconnectedness?

Storytelling for Policy Advocacy

The following is a repost from Josephine Ensign’s Medical Margins Blog. I first met Josephine a few years ago at the University of Iowa’s Examined Life conference, which she mentions in the post. She presented there on a topic I had not heard of: narrative advocacy. I’ve since read numerous examples of the genre, simply defined as stories told to move a reader to action. A beautiful example is her essay “Next of Kin,” on her work as a nurse with a homeless man, in the 2013 anthology I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse, edited by Lee Gutkind and published by In Fact Books. My colleague Jim Stubenrauch and I now require this book in our narrative writing courses at the Hunter–Bellevue School of Nursing. Josephine Ensign is a nurse practitioner, a writer, and an associate professor of community health at the University of Washington School of Nursing in Seattle. My thanks to her for this post and for her ongoing work as a writer, an advocate on behalf of marginalized patients, and a teacher using narrative to help nurses tell the stories policymakers need to hear.—Joy Jacobson, CHMP senior fellow

A common definition of narrative is a story with a teller, a listener, a time course, a plot, and a point. Storytelling is as old as campfires and cave-dwelling. (The photo here is of my father telling Appalachian ‘Tall Tale’ stories to his grandchildren.) Storytelling is how we learn about our world, about ethical living, about history, about ourselves. Within the healthcare arena patients and family members tell their stories to nurses and doctors and other members of the healthcare team. It is still a truism that something between 80-90% of the information needed to make a correct medical or nursing diagnosis comes from the patient’s history, from their story.

Storytelling and story-listening are not only important at the individual patient level. They are also important at the community and public health level. Stories can be effective ways to educate and persuade the public and lawmakers on a variety of health and policy topics. Storytelling (pathos) is part of Aristotle’s three essential components of rhetoric: the art of persuasion. The other two components of rhetoric are logic/reasoning/facts (logos) and the credibility of the speaker (ethos).

Several years ago at The Examined Life: Writing and the Art of Medicine Conference at the University of Iowa, I co-led a workshop “Narrative Advocacy: Writing Lives, Making Changes.” My co-leaders were Marsha Hurst, PhD, a core faculty member in the Program in Narrative Medicine at Columbia University, and Carol Levine the director of the United Hospital Fund’s Families and Health Care Project in NYC. Here’s the abstract of our workshop, which I still refer back to as my own guide and articulation of what I am passionate about:

Narrative advocacy is the practice of using narrative competencies to advocate for improvements in care. It involves moving beyond the individual stories, to include the connections made within the wider community, and acting upon common interests in order to effect positive change in clinical care, in institutions of caring, and in health policy. In the U.S. there is a long history of health advocacy built on narratives of lived experience of illness and disability, and more recently, grassroots narrative advocacy has expanded through the use of social media. For health care providers and students in the health sciences, narrative advocacy can be a powerful avenue for engagement in health policy because it connects the unique individual experiences with larger issues. As powerful as narrative advocacy can be to engage and persuade policy-makers, it can and has been misused. It is important to have both knowledge and skills in how and when to use narrative advocacy responsibly and ethically.

This past week I had the opportunity to participate in an excellent online training “The Role of Narrative in Public Health” sponsored by the Center for Digital Storytelling located in Berkeley, California and facilitated by Amy Hill. She gave four reasons personal stories are so powerful: 1) stories are universal and typically follow a familiar structure, 2) stories are intimate and touch the heart in a way facts/figures can’t, 3) stories are honest and aren’t as slick and sensationalized as they often are in journalism, and 4) stories don’t (typically) tell us specifically what to do. The Center for Digital Storytelling uses a participatory media and group process to help people create and share their personal stories. Working in groups makes the individual stories more powerful, and the process can be empowering and healing for the participants.

The Center attends to the ethical practice of digital storytelling (would be the same for any type of narrative/storytelling work I think). They ensure storyteller well-being, use principles of cultural humility, and adhere to a set of guidelines in working with people impacted by trauma. They point out that consent is an ongoing process, that the question of story ownership and of sharing and distribution of the stories should be clearly addressed from the very beginning of the project. Amy showed us several powerful digital stories from their various projects. My favorite was on motherhood and women’s rights from their “Silence Speaks” project: Dear Ayhan by Rawan Bondogji. A perfect story for Mother’s Day. It is beautifully done.

Here are some additional narrative advocacy pieces that I use in my teaching:

  • The WHO project “What’s Disability to Me” series, but especially Rachael’s story (UK nurse and her story of overcoming discrimination within the health care system including nursing school) and Faustina’s story (Tanzania).
  • Joshua Bennett Poetry Slam/Performs at the White House, an amazing poem about his relationship with his sister Tamara who is deaf.

Write of Spring: The Examined Life Conference

These past few years, it’s become a vernal ritual: in early April, just as the buds on the flowering pear trees are about to pop here in New York City, I get on a plane and fly to Iowa, where spring “may continue taking its time” to arrive. It seems perverse, I know. What could lure me again to the great, flat, frozen Midwest after a winter like we’ve had? The Examined Life Conference: Writing, Humanities, and the Art of Medicine, an annual gathering of health care providers and writers at the University of Iowa Carver College of Medicine—this year’s conference takes place April 10 – 12.

ExaminedLifeLogoAmong the featured presenters will be Andrew Solomon, whose most recent book, Far from the Tree: Parents, Children, and the Search for Identity, won the National Book Critics Circle award for nonfiction and many other prizes. (He’s also the author of a much-discussed New Yorker article, “The Reckoning,” based on his extensive interviews with Peter Lanza, the father of the Sandy Hook Elementary School shooter, Adam Lanza.) Also on hand will be Louise Aronson, a Harvard-educated geriatrician who holds an MFA from the Program for Writers at Warren Wilson College. She is the author of a short story collection, A History of the Present Illness.

I’m especially excited this year because CHMP Poet-in-Residence Joy Jacobson and I will lead a two-day preconference writing workshop, Writers as Healers, Healers as Writers, on Tuesday and Wednesday, April 8 – 9. There’s still time to sign up.

We don’t follow the format of the traditional writing workshop, in which participants critique drafts of stories, poems, or essays with an eye to improving their literary value. Rather, the focus of our workshops is on the writing process as an act of discovery and healing. We base our approach on the expressive writing method pioneered by psychologist James W. Pennebaker and colleagues, who have demonstrated a wide range of physical and emotional health benefits associated with intensive writing about trauma and other emotionally charged events. We’ve also adapted the methods outlined in Louise DeSalvo’s Writing as a Way of Healing: How Telling Our Stories Transforms Our Lives, itself an elaboration of Pennebaker’s expressive writing technique.

Also due in April is Expressive Writing: Words that Heal, coauthored by Pennebaker and John Evans. According to the Amazon blurb, “It explains why writing can often be more helpful than talking when dealing with trauma, and it prepares the reader for their writing experience. The book looks at the most serious issues and helps the reader process them. From the instructions: ‘Write about what keeps you awake at night. The emotional upheaval bothering you the most and keeping you awake at night is a good place to start writing.’”

Joy and I will post from the conference. Stay tuned. And enjoy the Rite of Spring!

–Jim Stubenrauch is a senior fellow at the Center for Health, Media & Policy
and teaches writing at the Hunter-Bellevue School of Nursing.

“All Searching Together”: Reflective Writing and Nursing Research in a Magnet Hospital

For many of us, writing doesn’t often come as easily as we’d wish. The dream is that our fingers will tap dance across the keyboard and the words will race across the computer screen, sentence after flowing sentence forming well-ordered paragraphs and well-structured arguments—and every once in a while, after lots of practice, that might actually happen. But that’s not most people’s experience most of the time. Many factors can contribute to the difficulty of writing; for students whose grades depend, in part, on the papers they write, or for professionals whose advancement depends on publication, worry about the judgment of others and the fear of not meeting the standard may become paralyzing. Because some of the barriers to effective writing are emotional, reflective and creative writing techniques can be helpful even in an academic or scientific setting.

I recently had the pleasure of joining with two colleagues to provide a two-day writing retreat for a group of nurses and physical therapists at NYU Langone Medical Center Hospital for Joint Diseases. HJD is a Magnet hospital, a designation the American Nurses Credentialing Center awards to institutions that demonstrate qualities of nursing practice and patient care outcomes that attract and retain highly qualified professional nurses. Magnet hospitals are centers of nursing research, and a condition of maintaining Magnet status is that staff nurses conduct such research and publish the results. Dr. Donna M. Nickitas, a faculty colleague at Hunter-Bellevue School of Nursing and the executive officer of the CUNY Graduate Center’s Doctor of Philosophy in Nursing program, had previously worked with groups of nurses at HJD to help them develop manuscripts for publication. For this two-day retreat, she invited CHMP poet-in-residence Joy Jacobson and me to collaborate on a program that, in addition to her own thorough overview of producing research articles, would use artistic means to help participants get into the flow of writing.

Photo caption: Participants in the NYU Hospital for Joint Diseases Winter Writing Retreat (from left to right): Gael Donchance, BSN, RN, Edward Creasy, MSN, RN-BC, CNOR, Donna Nickitas, PhD, RN, NEA-BC, CNE, FAAN, Annie Lu, MS, RN, ANP-BC, ADM-BC, Eslene Jeanty-Mayers, BSN, RN, Jennifer Withall, RN, ANM, Patricia Lavin, MS, BSN, RN, Joy Jacobson, MFA, Ella Blot, MSN, BSN, RN, Andrew Wuthrich, MSN, RN, ONC, Binita Desai, DPT, BPT, Jim Stubenrauch, MFA. Participants not shown in photo: Kimberly Volpe, MS, RN, and Elizabeth Pagano, PT, DPT, GCS, CSCS.

Photo caption: Participants in the NYU Hospital for Joint Diseases Winter Writing Retreat (from left to right): Gael Donchance, BSN, RN, Edward Creasy, MSN, RN-BC, CNOR, Donna Nickitas, PhD, RN, NEA-BC, CNE, FAAN, Annie Lu, MS, RN, ANP-BC, ADM-BC, Eslene Jeanty-Mayers, BSN, RN, Jennifer Withall, RN, ANM, Patricia Lavin, MS, BSN, RN, Joy Jacobson, MFA, Ella Blot, MSN, BSN, RN, Andrew Wuthrich, MSN, RN, ONC, Binita Desai, DPT, BPT, Jim Stubenrauch, MFA. Participants not shown in photo: Kimberly Volpe, MS, RN, and Elizabeth Pagano, PT, DPT, GCS, CSCS.

Joy and I engaged the group in creative activities that we often use in our writing classes and workshops, including readings and reflective writing prompts that stimulate the imagination and rekindle clinicians’ passion for their research topics. We asked the writers to read aloud from their own work and from published poems and essays, not only for their content but also to help the writers become more comfortable hearing their own voices and being heard by others. And each day, as a way to relieve stress, quell anxiety, and center the group’s awareness in the creative present, Joy led a guided meditation that I accompanied on harmonium, a small reed organ with a keyboard and hand-operated bellows. All of us focused our attention on our breathing, loosened our grasp on thoughts about work and worries about writing, and vocalized in tune with the harmonium’s drone. And then we wrote.

Jim with harmonium -- photo: Edward Creasy

Jim with harmonium — photo: Edward Creasy

On the second day of the retreat, we read a short excerpt from an essay called “Don’t Ever Forget Me” by Christopher Lance Coleman (the essay can be be found in an excellent anthology, I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse, edited by Lee Gutkind). Now a professor at the University of Pennsylvania School of Nursing, Coleman was a nursing student at the beginning of the AIDS epidemic, when a lack of knowledge about how the disease was transmitted instilled fear in many health care providers. Coleman begins his essay with an account of being on duty one evening and hearing weak cries coming from behind a hospital door marked with a sign that said: “Patient Has AIDS. Do Not Enter.” Defying the sign—and the rules for nursing students, who were then forbidden to care for AIDS patients—Coleman entered and found a woman who had dropped her fork and was too weak to pick it up and feed herself. Coleman fed the woman and vowed to himself that no AIDS patient would ever again go hungry on his watch. He’s spent the past 30 years doing hospice work with HIV/AIDS patients and conducting research in HIV/AIDS prevention.

Coleman’s story had special meaning for one of the writing retreat participants, Patricia Lavin, MS, BSN, RN. Now the director of nursing quality and outcomes at HJD, Lavin worked at St. Vincent’s Hospital in Greenwich Village during the worst period of the AIDS crisis. In all, she spent more than a decade as an emergency room staff nurse and critical care nurse and also worked in nursing management. She writes: “St. Vincent’s was the epicenter of New York City’s AIDS epidemic. It housed the first and largest AIDS ward on the East Coast and is often referred to as the ‘ground zero’ of the AIDS epidemic. Thousands of people were treated for HIV/AIDS at St. Vincent’s and many died; many more passed through to visit sick partners, friends, and family members. Although there were other important AIDS wards and treatment centers in New York City, none took on the symbolic and cultural significance of St. Vincent’s.”

Here is Lavin’s response to Coleman’s essay, an account of a time when “we were all searching together”:

Marching with the Unknown

Staring into the faces of the emaciated and frightened men with fevers of unknown origin

Knowing that they wanted answers and no one had them

Fear etched into their faces, searching for any glimmer of hope from the figures in white who drifted in and out of their rooms and their lives

They were frightened

We were frightened

They stared with disbelief at the path of destruction this unknown illness brought

We, their caregivers, stared too at the ravages of the unknown disease

At the loss of all that they loved

At the unknown . . .

One patient taunted me—beckoning me to see what a nightmare he was trapped in

I was a new nurse and every day I came in and tried to be upbeat and happy

I focused on the positive, day after day, when I walked through the door to care for him

But he was dying

He was afraid

He was alone

No one knew why

No one could help

We were all lost, we were all searching together, and no one had answers in 1984

By 1988 I was working in Greenwich Village at the height of the epidemic

Now we had a name—AIDS

We knew that HIV was the cause

But it did not stop the ravaged bodies coming in through the Emergency Room doors

It did not stop the suffering, the pain and the fear

So much fear

So many questions still unanswered, how long could this go on for?

How many more would suffer?

Who else would die?

Your neighbor, your friend, your lover, your brother, your uncle, your father . . . ?

People praying,

People hoping,

People crying,

People suffering,

Agony and then courage, yes oh the courage and then action!

Marching in the streets in New York City and across the country

Demanding answers, demanding to be heard

Crowds of angry young men breaking down the doors in our Emergency Room lobby

Curtains and drapes being dragged off the windows,

Spray painted body forms painted on the sidewalk, painted in the lobby as reminders of their pain and of their dying bodies

When would it stop??

When would all the anguish turn into answers??

Death still came as the years turned into decades

It only marched slower now,

It took longer to come

But it still came . . .

–Jim Stubenrauch is a senior fellow at the Center for Health, Media & Policy
and teaches writing at the Hunter-Bellevue School of Nursing.


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